Jefferson Journal of Psychiatry最新文献

{"title":"An Historical Review of Electroconvulsive Therapy","authors":"B. Wright","doi":"10.29046/JJP.008.2.007","DOIUrl":"https://doi.org/10.29046/JJP.008.2.007","url":null,"abstract":"T he initia l clinical tria l of electroco nvu lsive th erapy (ECT) was performed by Ugo Cerletti and Lucino Bin i at th e U niversity of Rome in 1938. T he following paper will exam ine both the developments wh ich led to the first trial of ECT, and th e use of ECT over th e subseque nt fifty years. Hopefull y, by inv est igating the historical aspect s of the development and progression of ECT , a bette r understa nding of this treatment modali ty ca n be attained. T he therapeutic use of electricity was not unique to ECT. T here is evidence th at Ancient Romans used th e cu r rent generated by electric eels for the treatment of headach es, gout, and to assist in obstetr ica l procedures. The recent his tory o f th e th erapeutic use of electricity dates to 1744 when th e journal entitle d \" Electr icity and Medicine\" was firs t publish ed. It was claimed here that elec tric stimu li co u ld be curative for \" neurologic and mental cases of paralysis and ep ilepsy (1).\" J.B. LeRoy in th e 175 5 ed ition of \" Electr icity and Medicine\" detailed a case of hyste rical blindness whic h was cured with three applicat ions of e lectric shock (1). In 1752 , Benjami n Franklin recorded th e use of an \"elec tro static mach ine to cu re a woman of hys terical fits (2). \" By th e mid 19th century the use of electrothera py had so progressed that G.B.C. Duchenne (often refer red to as th e Fath er of Electrotherapy) would say, \"No sin ce re neurologist could p ract ice wit hout the use of electrotherapy (1).\" Bu t , despite th e documented use of electrotherapy through th e 19th century, there is little ev idence that th is was of any influence in th e development of ECT. The historical emphasis in the medicina l use of electricit y was on the electric st im ulus in and of itsel f, whereas the e lectricity in ECT was used solely for its co nv u lsan t proper t ies. A more important co ntribution to the development of ECT was th e work of Jul ius Wagner-Jauregg . It was a co mmon observation in th e lat e nineteenth ce ntury tha t a wide variety of d isorders often improved clinically following febrile ep isodes. Wagner-Jau regg, in 1917 , attempted to a lleviate the symptoms of dementia paralyti ca (neuro-syphilis) by ind uc ing fever with th e intram uscular injection of blood from patients with ma laria. Of th e fir st nine patient s he investigated, three had a complete recovery, three had a temporary symptom-","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128612331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric Training: The Culture and Its Contradictions by T.M. Luhrmann","authors":"C. Myers","doi":"10.29046/jjp.016.1.009","DOIUrl":"https://doi.org/10.29046/jjp.016.1.009","url":null,"abstract":"","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126819017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Psychiatric Presentation of Wernicke's Encephalopathy Following Intravenous Fluid Administration","authors":"D. O. D. Geenans","doi":"10.29046/JJP.010.2.003","DOIUrl":"https://doi.org/10.29046/JJP.010.2.003","url":null,"abstract":"Psychiatrists arefrequenlly challenged to differentiateprimarypsychiatricsymptomsfrom those that arise secondary to medical illness. Errors in clinical assessment can lead to significant morbidity and even mortality. Wernicke's encephalopathy is a medical condition that presents, in part, as psychiatric symptomatology. Despite an estimated incidence of2%, 80% qf the cases are undiagnosed. Of its classic triad, ophthalmoplegia and ataxia call be quite subtle, oreven absent, whereas mental status changes are present in all but 10%ofcases. This disorder, although widely recognized as a complication ofalcoholism, has many lessftequently considered etiologies, including iatrogenic causes, which may constitute a largefraction ofthe unrecognized cases. The authorlooks at a caseofWemicke's encephalopathy that was iatrogenically induced andpresentedaspsychiatric symptomatology. Wernicke's ence phalopa thy is a medi ca l condition which results from impaired intestinal absorpt ion of thiamine. It s pr imary manifest ations a re neurological and psych iatric, however its neurologica l seque lae (ophtha lmo pleg ia a nd a taxia) are ofte n subt le and a high ind ex of suspicion is essen tia l to conside r th e diagnosis (I). Dist urbances of consciousness an d mentation are typica l and pr esen t in all but 10 pe rce nt of pat ients (2) . The following ca se illust rates a primarily psych iatric presentat ion of the illn ess, followin g int ravenou s fluid administ ration, in a 3 1-yea r-old man with hypere mesis and protract ed hiccups.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133879263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Usefulness of Neutrality","authors":"Julia Jones Zawatsky","doi":"10.29046/JJP.005.2.002","DOIUrl":"https://doi.org/10.29046/JJP.005.2.002","url":null,"abstract":"","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128406411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Countertransference and Inpatient Psychiatry: Theoretical and Clinical Aspects","authors":"Edward Kim","doi":"10.29046/JJP.006.2.010","DOIUrl":"https://doi.org/10.29046/JJP.006.2.010","url":null,"abstract":"Few aspects of psychiatric trammg are more troubling to beginning resid ents than the emerging awareness of their own co untertransferences. This is often viewed with a mixture of disgust and em barassment as a sign of incompetence and lack of professionalism. Conflicting views on th e or igi ns of, and appropriate responses to countertransference furth er add to the di fficul ty and anxiety of psyc hiatric training. The frustration a nd se nse of helplessness which often accompany these feelings can lead to disillusionment a nd various degrees of acting out which ul timately compromise patient ca re and resid e nt education. Ironicall y, th e feeling of being overwhelmed by co untertra nsference can often occur several months into a psychiatric resid ency. Once beginni ng residents have acquired th e basic clinical skills needed for acute diagnosis and treatment, subtler issues in patient management arise . The greate r degree of psychiatric patient contact and greater difficulty in maintaining professiona l distance through procedures and lab stud ies makes this inevitable. It is often no t until th e outpatient yea rs when residents begin to treat \" h igher func tion ing\" patients that psychodynamic ed ucatio n is deemed clinically useful. Co untertransference, like other psychodynamic topics, ma y be view ed as \" ir re leva nt\" to inpatient psychiatry, which emphasizes biological and behavioral inter ventio ns. At all levels of training, howe ver, acquiring a systematic understanding of cou ntertransfere nce ma y be one of the most anxiolytic and educat iona lly use ful advances a resident can make.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128537739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intractable Alcoholism in a Patient with a Levine Shunt","authors":"B. Blumenthal, H. Field, E. Gottheil, M. Guerra, W. Maddrey, R. Serota, E. Shaw","doi":"10.29046/jjp.003.1.012","DOIUrl":"https://doi.org/10.29046/jjp.003.1.012","url":null,"abstract":"Ellen S haw. M. D., Fellow in Hepatology: Mr. J is a fort y-six-year-old white male who was initially seen on th e medical service in July 1982. At that time he presented with hepatic encepha lopathy, jaundice, and ascites . A liver biopsy was per formed, confirming the clinica l diagnosis of a lcoholic hepati t is superimposed on cirrhosis. Following dischar ge it was difficult to mainta in Mr. J as an out patient. He did not follow dieta ry rest rictions or ta ke diur et ics as presc ribed . Addit iona lly he was unable to control his drinking. Fina lly about a yea r ago a Levine shunt was imp lanted in an effort to control his asci tes . Subsequently he did well for a period of several months. He was ab le to abstai n from alcohol with a resu lt ing decrease in his ascites and jaundice. Recent ly he has resu med drinking, with a retu rn of his sym ptoms. He has missed his last several appointments in the clinic. Co nt rol of his medical pro blem s rem ains problemat ic unless his alcohol abuse ca n be bett er controlled. Willis C. Maddrey , M.D., Maggey Prof essor and Chairman of the Department of Medicine: I a m grateful for th e opportunity to discuss thi s te rrible problem . I know this pat ient, as ma ny of you do. He is prototypical of a group of patients in whom cirrhosi s a nd a ll of its complicati ons induced by a lcohol has led to a complex situation that is a downw ard spira l. As Dr . Shaw relat ed , th is man developed cirrhosis, the major mani fest ati on of which was ascites. If he would trea t himself appropri at ely, that is to say, be a bsti nent and ta ke diuretics, in addit ion to his Levine shunt, then his life expecta ncy would be reasona ble, about ten yea rs. Once you get cirrhosis your life expecta ncy dr ops remarkabl y. But if Mr. J were to take care of himself he would probabl y be a ll right for about ten years . Our pro blem , therefore, is th is pa tient' s persist ent addiction to alcohol. As you know, when this patient dried out, he took a look a t his life and decid ed it was bett er to be an a lcoholic . T hat's our probl em . Wh at I would like to talk about is the pa rt I work with the most: the physica l consequences of a lcohol abuse . You are a ll aware of the stat ist ics, but they are wor th reviewing. A bout one in ten chronic a lcoholics will develop cir rhosis . A chronic alcoholic to a hepat ologist is someo ne who dr inks more than sixteen ounces of eighty-six proof whiskey or its equivalent a day. I'm not using a socia l definition . T here a re people who are imp aired a t less tha n that and ot her s who are not a t much more than tha t. In fact, I have a number of pa tients with minimal liver abnorm alit ies in whom I'm relat ively ce rtain tha t they're telling me the truth when the y tell me the y","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115787894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant Pharmacotherapy: Prescription Practices in Psychiatric Resident Care","authors":"R. Dew, Vaughn McCall","doi":"10.29046/JJP.019.1.003","DOIUrl":"https://doi.org/10.29046/JJP.019.1.003","url":null,"abstract":"Background: Research on treatment of depression has raised concerns regarding adequacy of medication trials and rationality of drug choice. Little data exists regarding pharmacotherapy by psychiatric residents. As practice habits begun in training will likely persist after graduation, examination of residents' antidepressant use may ultimately improve treatment by psychiatrists. Methods: Charts of new patients presenting to the Wake Forest University Psychiatry Resident Clinic were reviewed. Survey was made of medications prescribed to 112 patients diagnosed with major depression, dysthymia, depressive disorder NOS, adjustment disorder with depressed mood, or bipolar disorder with a documented depression during the studied period. Drug choice and maximum dose were noted. Results: Most-prescribed antidepressants included sertraline, trazodone, citalopram, mirtazapine, venlafaxine, and bupropion. The most used tricyclic antidepressant was amitriptyline (n=7), with an average highest dose of 110.7 mg per day. No MAOIs were prescribed. Augmentation treatment with lithium was prescribed twice and thyroid hormone once. No patients received ECT. Conclusions: Depressed patients in this resident clinic were treated primarily with SSRIs and other newer antidepressants. Little use was made of TCAs, MAOIs, ECT or traditional augmentation strategies. Further research should aim to determine whether more education in older antidepressant treatment modalities should be emphasized.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127761543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climbing through the Milwaukee County Civil Commitment Process","authors":"Jon A. Lehrmann","doi":"10.29046/jjp.011.2.007","DOIUrl":"https://doi.org/10.29046/jjp.011.2.007","url":null,"abstract":"Civil commitment has become a practically unavoidable process .for today's practicing psychiatrist. It creates a complicated triangular relationship involving the legal system, the medical system, and the pat ient. This article is a first person narrative qf a case which helps describe the Wisconsin civil commitment process as it operates in Miltoaukee County. It illustrates the frus trations that a psychiatrist (and in this case a fi rst year psychiatry resident) can experience in such a system. Finally, it addresses these problems associated with civil commitment and discusses possible solutions. I first becam e initia ted into th e Mi lwaukee County (W isconsin) civil commitment process duri ng my firs t year of psychia try train ing. During my first test imony, I had been qu es t ion ed sa tisfactorily by th e patient 's attorney, and th en the Cou nty a tt orney ask ed me confide n t ly, \" Doc to r, how lon g have you been a psych ia t ry resid ent?\" I a nswe red, \"abo ut two weeks.\" Wh en th e j udge a nd everyone else in th e court room finall y st opped lau ghing and my emba rrassme nt had fad ed , we were ab le to put th e focu s back on th e issu e at hand. Wi th tha t being my introduction to th e fru stration of th e Mil waukee County civil com mit ment sys te m, I now use it as a prologue for a case report whi ch illust rat es ma ny of the shortcomings of that syst em, as well as the com plexity of th e Wiscon sin laws of com mit me nt, as th ey are practi ced in Milwaukee Co unty. Work ing with this patient showed me th e importan ce of th e in terface bet ween th e legal syst em and psychiatry. This is th e case ofj.S. (ce rtain identifyin g features have been changed for th e sa ke of confide n tia lity). j.S. is a 4 1 year old woma n diagnosed wit h chronic schizophre nia . She had bee n hospi talized many times over the last 20 yea rs sec ondary to psychot ic st a tes which usually occurred aft er Miss S. had stopped ta kin g her pr escribed neu rol epti c medication. Sh e becam e quit e dangerous at th ese times developing delu sions focus ed on a need for excessive weight loss. In May of 1990 , Miss. S. was hosp itali zed under simila r circumsta nce s. Two mont hs previous to this admission, becau se of a simi lar episode of dangerous weigh t loss, her fat her had been appointed her tempora ry gua rd ian. J on A. Lehrmann, M. D. is a PGY-III res iden t in th e Dep artment of Psychi a try a t the Medical Co lleg e of Wiscons in in Milwaukee.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127029890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"So Much Success, So Little Joy","authors":"D. Gerstman","doi":"10.29046/jjp.011.1.007","DOIUrl":"https://doi.org/10.29046/jjp.011.1.007","url":null,"abstract":"This biography was published in 1989 as a tribute to C harles Schultz's fortiet h anniversary of publishing Peanuts. The longevity of his ca r too n and th e fact th at he has drawn eac h strip by himself is unique. His characte rs a re known in eve ry contine nt and their trials and tribulations a re translated into ove r twe nty la nguages every day. So why would I recommend this book to th e ge neral pu blic, and to psychiatrist s and m ental health professionals in pa rt icul ar? Becau se in this authoriz ed biography, Rheta Grimsley J ohnson, a nation ally ren owned syndicated columnist , shows how a man do es not hav e to be crippled by his mental illness and how thi s man in particul ar could not have becom e what he is today without coming to terms with agorophobia a nd depression . The ea rly chapte rs describe how Schultz grew up in Minnea polis as an only child who was close to his mother and fa the r. Significa n t mil eston es from his life are ment ioned , in pa rticul ar th ose whi ch see m to be reflect ed in Peanuts. For example, th e whole family moved to Nee dles, California during the Grea t Depression whil e his fa t he r looked for work , eve ntually moving back to Minneapolis whe re he graduated from high school. In sch ool he was a C stude n t with very few friends, spe ndi ng most of his lun ch hours by himself a nd feeling intimidated by th e others. A whole chapter is devot ed to th e woman on whom The Little Red H aired Girl is based. We see th at his popular charac te r Charlie Brown re flec ts som e of Schultz's own ex periences and feelings. The crit ica l point in his life, according to Johnson , was his draft in to World Wa r II th e same week that his mother died fr om ca nce r . H e never had th e opportunity to say goo d-bye to his mother and according to J ohnson, thi s was a n issu e he never succes sfully re solved. H e returned from th e war a nd soug ht work as a n a rt illust ra tor and as a fr ee lan ce ca r toonist for newspapers whil e waiting for his big chance to be publish ed in a major newspap er. The middle chapte rs furn ish more detail on how Schultz was ab le to get Peanuts publish ed and eventually known in every corner of th e globe. The remaining chapte rs show what day to day ope ra tio ns a re curre n t ly like with Schultz working in his stud io in Sa nta Clara, Califo rn ia . J ohnson mak es clear referen ces through out thi s boo k to th e fact that Schult z","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122885732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Response: A Practical Approach to the Assessment and Management of Psychiatric Emergencies","authors":"W. Dubin","doi":"10.29046/jjp.008.1.011","DOIUrl":"https://doi.org/10.29046/jjp.008.1.011","url":null,"abstract":"I would like to respond to the article e n t itled \" A Practi ca l Approach to the Assessment and Management of Psychiatric Emergencie s\" (Jefferson J ournal of Psychiatry, Vol. 7:8 I -9 1, 1989). The au thors are to be co ngratulated for their concise distillation of the major clinical problems encountered in emergency psychiatry. However, there are several aspects of this r eview which require further amplifica t ion and clarification . The authors tend to emphasize drug therapy. While d rug treat ment is an integral part of emergency psych iatry, an understandin g of th e psychodynamic issues related to violence, su icide, an d adjustment disorders ca n frequently facilita te a psychologica l rein tegration fo r the patient and reduce or obvia te the need for med ica t ion . Furthermore, in the treatment of personal ity d isorders, substance abuse patients and depressed and/or suicida l patients, and ge riatric emergencies, timely family intervention by enlisting the help o f th e pat ien t 's support network ca n frequently atten uate the emergency, minimize med ication and avert hospital izat ion. T he irony of emergency psychiatry is th at like a ll emergency med icine, the em phasis is generally placed on rapid intervention and disposi tion. Paradoxica lly in emergency psych iatry, \"tincture of time\" is o ften a power ful tr ea tment intervention. Obviously, the abi lit y to em ploy psych o therapeutic interventions is dependent on space and staff availability. Specifica lly addressing severa l issues raised by the authors, I was curiously struck by the sta te ment that \" the psych iatrist should never tak e part in any pat ient restrain t, but rather g ive orders an d d irect the action .\" It is no t quite clear to me why psychiatrists shou ld never take part in any patient restraint. T here is no ev idence to ind icate that such interventions would di srupt a therape ut ic rela tionsh ip. Assuming that a psyc hiatrist is knowledgeabl e in restrain t procedures and adept at th is techniq ue , I bel ieve that th e psychi at r ist should active ly invol ve him/hersel f since part of his /her task is to rol e-m odel approp riate treatment interventions fo r o ther staff. At o ther times, th e psychiatrist may in fact be th e most ill-equipped member of a team to give orders and di rect ac tio n and frequently psych ia tr ic tech nicians or nursing staff are more experienced and skillfu l in restra int procedures. I think that the invol vement of","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133489012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}